Skin and Musculoskeletal Flashcards
Skin is waterproof, protective, and adaptive. Other functions?
Protection from environment, perception, temp regulation, identification, communication, wound repair, absorption and excretion, production of vit D
Skin in infants?
Temp regulation, hot and cold. Eccrine sweat glands are not effective initially. Subcutaneous tissue. Decrease in pigmentation.
Skin in children?
Epidermis thickens, darkens, and becomes lubricated. Hair growth accelerates.
Skin in adolescents?
Secretions from apocrine sweats glands, sebaceous glands increase. Subcutaneous fat deposits increase. Secondary sex characteristics: areola, pubic and axillary hair, facial hair on men
What happens to skin in the aging adult?
Loses elasticity, skin folds and sags. Decrease in number and function of sweat and sebaceous glands. Discoloration due to increasing capillary fragility: senile purpura. Cell replacement is slower and wound healing is delayed. Functioning melanocytes decrease, leading to gray fine hair.
Subjective info for the skin?
Previous history of disease, change in moles and pigmentation, excessive dryness or moisture, pruritus excessive bruising, rash or lesions, medications environmental or occupational hazards, self-care behaviors.
How do you inspect the skin?
General pigmentation, freckles, moles, birthmarks. Widespread color change, noting any color changes. Texture, turgor
If lesions are present, what should be noted?
Color, elevation, pattern or shape, size, location and distribution on body, any exudate. Use a Wood’s light.
Shapes and configurations of lesions?
Annular or circular, confluent, discrete, grouped, serpiginious, grate, target, linear, zosteriform
ABCDE skin assessment?
Asymmetry Border Color mixture or change Diameter greater than 6mm Elevation, evolution, enlargement
The outer, highly differentiated layer of skin?
The inner, supportive layer made mostly of collagen?
The layer beneath?
Epidermis
Dermis
Subcutaneous
From the basal cell layer of skin, new cells migrate up and flatten into what outer layer? It consists of dead keratinized cells that are interwoven and tightly packed.
Horny cell layer
The epidermis is replaced every four weeks.
When does cyanosis occur?
It indicates hypoxemia and occur with shock, cardiac arrest, heart failure, chronic bronchitis, and congenital heart disease.
What does the pallor of shock often present with?
Rapid pulse rate, oliguria, apprehension, and restlessness.
Solid raised lesion that has distinct borders and is less than 1 cm in diameter.
Papule. May have a variety of shapes in profile (domed, flat-topped, umbilicated) and may be associated with secondary features such as crusts or scales.
Solid, raised, flat-topped lesion greater than 1 cm. in diameter. It is analogous to the geological formation, the plateau.
Plaque
Raised lesions less than 1 cm that are filled with clear fluid
Vesicle
Circumscribed clear- fluid-filled lesions that are greater than 1 cm. in diameter.
Bullae
Flat lesions on the skin less than 1 cm in size? Greater than 1 cm?
Macule
Patch
A closed capsule or sac-like structure, usually filled with liquid, semisolid, or gaseous material.
Cyst. Usually occur within almost any type of the body’s tissue; they vary in size from microscopic to large structures that can displace internal organs.
Circumscribed elevated lesions that contain pus. They are most commonly infected
Pustule
What is jaundice and what does it occur with?
Rising amounts of bilirubin in the blood. First noted in the junction of the hard and soft palate in the mouth and in the sclera.
Hepatitis, cirrhosis, sickle-cell disease, transfusion reaction, and hemolytic disease of the newborn.
What does erythema occur with?
Polycythemia, venous stasis, carbon monoxide poisoning, extravascular presence of red blood cells.
Profuse perspiration that accompanies an increased metabolic rate such as occurs in heavy activity or fever. What else can it occur with?
Diaphoresis. Thyrotoxicosis, heart attack, anxiety, pain.
How does skin feel with hyper and hypothyroidism?
Hyperthyroidism skin feels smoother and softer, like velvet.
Hypothyroidism skin feels rough, dry, and flaky.
What are the three types of muscles?
Skeletal, which is voluntary. Smooth and cardiac, which are involuntary.
Explain synovial joints.
Most common, freely moving. Bones separated from each other and enclosed in a joint cavity filled with fluid that allows sliding of opposing surfaces.
Ankle, wrist, thumb, hip, knee, etc.
Explain nonsynovial joints.
Consist of bones united by fibrous tissue or cartilage. Immovable. Cartilaginous joints.
Manubrium, sternum, spinal column, pubic symphysis.
What subjective data should be asked about the musculoskeletal?
Joints, functional assessment, self-care behaviors, muscles, bones.
Fibrous bands running directly from one bone to another bone that strengthen the joint and help prevent movement in undesirable directions.
Ligaments
How to inspect for musculoskeletal?
The size and contour of joints, as well as the skin and tissues over the joints for color, swelling, and masses or deformity. Scoliomotor, movement, gait.
Complete loss of contact between the two bones in a joint.
Two bones in a joint stay in contact, but their alignment is off.
Dislocation
Subluxation
Shortening of a muscle leading to limited ROM of joint.
Stiffness or fixation of a joint.
Contracture
Ankylosis
What can possibly cause swelling in joints?
Excess joint fluid (effusion), thickening of the synovial lining, inflammation of the surrounding soft tissue (bursae, tendons), bony enlargement
What to palate for musculoskeletal?
Skin temp, muscles, bony articulations, area of joint capsule.
Disease inside the joint capsule that produces swelling and tenderness around the whole joint, limiting all planes of ROM in both active and passive motion
Articular disease. Arthritis, eg.
Disease that involves injury to a specific tendon, ligament, or nerve. Produces swelling and tenderness to that one spot in the joint and affects only certain planes of ROM, especially during active/voluntary motion.
Extra-articular disease.
Grades of muscle strength? Six of them including zero
5: Full ROM against gravity, no resistance; normal
4: Full ROM against gravity, some resistance; good
3: Full ROM with gravity, active; fair
2: Full ROM no gravity, passive; poor
1: Slight contraction; trace
0: No contraction; zero
May cause limited ROM pain, and muscle spasm during abduction. Forward flexion stays fairly normal.
Rotator cuff lesions
Measures joint movements and angles.
Goniometer
How does edema mask skin color and pathologic conditions?
The fluid lies between the surface and the pigmented an vascular layers. It makes dark skin look lighter.
Which spinous processes are prominent at the base of the neck?
C7 and T1
The inferior angle of the scapulae is normally at the level of what?
The interstitial space between T7 and T8.
An imaginary line connecting the highest point on each iliac crest crosses what?
L4
An imaginary line joining the two symmetric dimples that overlie the posterior superior iliac spines crosses what?
Sacrum
